WQCS00012_ORC Designation Form_20241108

Water Pollution Control System OPERATOR IN RESPONSIBLE CHARGE (ORC) Designation Form
NCAC 15A 8G .0201
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Facility Name: Cape Fear Public Utility Authority Permit # WOCS00012
Facility Type/Classification: CS 0 Facility Grade: IV 0 SUBMITASEPARATEFORMFOREACHCLASSIFICATION
Permittee Owner/Officer Name: Kenneth Waldroup
Email Address: [e-mail]
Permittee Signature:-761 Date: _ )
ORC
Full Name: Christopher AnthonyBene asi Work Phone: [phone]+1g6
Email Address: Christo her.Bene [e-mail]
Certificate Type: CS 0 Certificate Grade: IV 0 Certificate #: 1006647
1,
Signature:_ l Effective Date: / Z
certify that I agree to my designation as the OperMt In Responsible Charge for the facility noted. l understand and wilt abide by the ►u and r lotions pertaining
to the responsibilities of the ORC as set forth in 15A NCAC 08G.0204 and falling to do so can result In Disciplinary Actions by the WPC30CC
Full Name: Collin Scott Whitehead
Backup ORC
Work Phone: [phone]
Certificate Type: CS Certificate Grade: IV 0 Certificate M 1014412
Signature: Effective Date: lU''d
"1 certify that I agree to my designation as the Operator in Responsible Charge for the facility noted. 1 understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth in 15A NCAC 08G .0104 and falling to do so can result in DlsciplinaryActlons by the WFCSOCC"
Backup ORC
Full Name: Angelo Lonell Walker Work Phone: [phone]
Certificate Type: CS 0 Certificate Grade: III El Certificate #: 1006128
Signature: 4mydesi!�JtZf..
Effective Date: AQ"1 certify that I agree to as the Operator in Responsible Charge for the facility noted. I understand and will abide by the rul and regulations
pertaining to the responsibilities of the ORC as set" in 15A NCAC 08G .0204 and falling to do so can result in Disciplinary Actions by the WPCSOCC"
Email this form to: [e-mail]
AND
Send to your DEQ Regional Office (send to your contact or find emails here: www.deq.nc.gov/about/contact/regional-offices
or fax using this drop down list: Choose DWR Re
gional Office that has coverage of this facility.
Use the 2nd page only if you need to Nst additional Backups.
ReWsed OZ2024